Insurer balks at $25,399 chopper bill

Watching her injured son fly away in a medical emergency helicopter without her was not Heidi Calhoun’s first choice.
She asked the emergency room doctors at Troy’s Samaritan Hospital if the 15-year-old couldn’t be treated for his burns at Albany Medical Center. No, they said, he needed care ASAP at Westchester Medical Center’s specialized burn unit.

Couldn’t he travel by ground ambulance, so she could ride along — or perhaps with his older sister, who is a licensed practical nurse?
Again, the answer was no. That would mean too much precious time spent on the road, away from the kind of high-level care available in a hospital emergency room.
Young Joe Dobert had sustained vapor burns to his face, neck, hands and arms after using gasoline to start a fire. He was trying to dispose of brush on his grandparents’ land next door in rural Schaghticoke.
He was in severe pain, and there was concern that gasoline vapors had permeated his skin and were continuing to cause damage. So, doctors gave the green light for an unusual helicopter transport from Troy to Westchester County.
Five months later, Dobert has recovered remarkably well and shows few signs of the scars that could have disfigured his face. For that, he and his family thank a series of caregivers that started with the Pittstown Volunteer Emergency Corps and Mohawk Ambulance crews, continued with the emergency room staff at Samaritan and concluded with the emergency room and burn unit staff at Westchester.
Calhoun’s thankfulness for her son’s strong recovery is tempered by a new anxiety, though. It struck when she opened her mail one day early last month and found a $25,399 bill for the helicopter trip.
“I’ve been a basket case,” Calhoun told me as we talked in her kitchen. “This is really scary.”
Calhoun, who works at home providing Medicaid billing services for school districts, puts health insurance high on her list of financial priorities. She says it’s something she can’t afford to ignore, since she, her husband and her ex-husband, who is Joe’s father, all are self-employed.
“You do not want to be financially devastated by medical costs,” she said.
Calhoun buys state-subsidized Healthy New York insurance to cover herself, her husband and her oldest daughter for about $750 a month and Child Health Plus coverage for her three younger kids for another $45 a month. Both plans are administered through Capital District Physicians Health Plan.
She appealed CDPHP’s denial of benefits for the helicopter transportation, but her appeal was denied. CDPHP wrote:
“The requested coverage for airbourne (sic) ambulance service is not available because such treatment is not a defined benefit in this member’s coverage plan. …Section Ten-36 of the Child Health Plus Contract excludes coverage for health services prescribed by a physician but not expressly covered by the contract.
“Although we are sensitive to your situation, please understand that we are bound by your contract guidelines and limitations.”
As I started making calls to CDPHP, Samaritan Hospital and others, I figured there must be some sort of mistake. This was, after all, a step that doctors deemed necessary for Joe’s emergency care.
Unfortunately, I was wrong. What I found was a deep and treacherous gap in coverage for children who are insured under Child Health Plus.
It’s unclear how often families are caught in this gap, but it’s obviously more significant for those who live in rural areas and upstate, where doctors and rescue squads are more likely to call on air transportation services to move patients quickly over long distances.
“This has come up before, but it’s very rare,” said Claudia Hutton, a spokeswoman for the state Health Department.
Since the department does not routinely track services that are not covered by CHP, she said, there are no exact data available on how many families have had the same experience as Joe Dobert’s. Adding coverage for emergency air transport is not currently part of the governor’s proposed budget, she said.
There is, however, some hope that Dobert’s family will be spared at least the brunt of the helicopter bill.
“This person is a member of the plan, and we are going to go to bat for the member, especially since it appears there were some process issues in the ordering of the air transport,” said Robert Hinckley, senior vice president for government and external relations at CDPHP.
“We are going to reach out to the hospital and the air ambulance company to see if we can reach a solution,” he said. “We’re going to do what we can to see that the member liability is either reduced or eliminated.”
But even if Calhoun and her family can be relieved of this heavy financial burden, I wonder whether the next family whose child is airlifted for emergency medical care will be protected.
State Sen. Tom Duane, who chairs the Senate Health Committee, agrees that transportation often is a critical component of providing medical care in New York.
“Part of the care is getting to the care, because it doesn’t exist everywhere,” he said.
Yet, Duane said his first suggestion for addressing such coverage shortfalls is not to add state requirements for air ambulance coverage. Rather, he pointed to funds already allocated in New York for so-called “bad debt and charity care.”
“Because there is a gap, it may be that we should encourage the referring hospital, the hospital that took the patient in, as well as the managed-care plan (CDPHP) to come up with funds to cover the cost, including money set aside for charity care,” Duane said.
“I believe that this is a rare occurrence, but that is why we have charity care,” he said.
It is not unusual for insurance coverage to fall far short of the actual cost of providing air ambulance service in an emergency, said Craig Yale, vice president of corporate development for Colorado-based Air Methods Corp., which operates the helicopter that carried Joe Dobert.
Yale said the company’s Life Net service is expensive because the aircraft must be constantly available and staffed with high-level paramedics, nurses and pilots. Medicaid reimbursements cover less than the cost of fuel, and many insurance plans cap coverage far below actual costs, he said.
Yale said that when patients are hit with high air transport bills, they are encouraged to contact the company’s billing office and ask for charity consideration.

38 Responses

This case sounds like a rare one, but none the less, an unfortuneate one for the family stuck with the bill. I wouldn’t exactly call it a “deep, treacherous gap” in Child Health Plus either. We should be grateful such a program is in place to cover what it does cover. Let’s not get crazy here and start mandating CHP cover all kinds of things and then make it unaffordable.

On a semi-realted topic though, I belive the use of helicopters ahs gotten a little out of hand. I would like to see some stats how poeple were “saved” by helicopters instead of an ambulance ride. When you think about it, the patient is ready to go, waiting in an ambulance for the helicopter to arrive so they can get to the hospital faster? Wouldn’t it be the same amount of time if you just got going in the ambulance? All I know is I once saw a motorcycle accident on exit 8 of I-90. The helicopter was called in to take the man to Albany Med. He was treated and released with a broken arm. Sometimes I think the fire department and cops just want to see the helicopter so they make the call.

Takeaways: If you are concerned about quick access to helathcare, move in from the sticks and closer to major hospitals in the city. Also, a 15 year old (or any-year old) using gasoline to start a fire is not a good idea.

Air ambulance coverage is a contractual exclusion of the CHP contract. Contractual exclusions shouldn’t be covered, period. If you read your own health insurance contract, I bet you would be surprised as to what is NOT covered. No one bothers to actually read their contract,it seems or they might have known about this ahead of time.

As for starting the fire with gasoline, does anyone else think that’s not the smartest approach? I’m not saying he deserved to be injured, but perhaps the entire, expensive episode of care could have been avoided if a 15 year old hadn’t been allowed to start what could easily be forseen as a dangerous fire?

The Barnster – EMS personnel have a protocol to adhere to. If they don’t call the helicopter when the criteria is met, it’s their butt on the line. Yes, there have been times when airlifted patients have walked out of the ER but again, if they accident meets the criteria they have to use it (unless weather or other factors are involved).

What about the homeowner’s insurance? He was burned on the grandparent’s property – they should go after the homeowner’s insurance policy to see if it covers that. I know if it was his own home it wouldn’t, but again it’s the grandparents home.

I do not agree with this advocate article either. If I was in enough trouble to warrant a trip via helicopter and it saved me then I would be grateful.

I think once the helicopter is called, you realize insurance is not going to pick up the bill. I am very happy he is alright, and maybe try using something a little less explosive like kerosene or citronella as this would do the same thing without the 25K bill.

I am appalled at the comments on this article. I would like to see what you would be writing if it was your 15 year old son with severe burns….The mom was in a complete state of shock, and as I am sure many of us have been, too upset to really think rationally past what the professionals that are caring for our loved ones are suggesting. I am sure health insurance was the farthest thing from her mind. As far as him using gasoline, well of course it was not the smartest thing to do, but that does not mean anyone could have foreseen what was going to happen. I camp regularly and have seen many grown men starting fires at the campgrounds with gasoline…this lack of judgement is not limited to teenagers. This was a totally unfortunate accident that could have been alot worse. The one post said she/he would be grateful if it saved her life, as I am sure the mom was so grateful for the care he received, however, lets see how you would react when you have been paying for health insurance, assuming because the professional staff said this was necessary, and suddenly out of no where you got the bill for $25,000 as being denied. Again, it goes back to the quality of the patient’s care versus what the patient can pay for. Maybe some blame has to go to the hospitals…they ask all about insurance and they should be aware if a helicopter is covered…if they are, maybe they could give the average patient in an emergency crisis a heads up?? I just pray that I am never in this position, because I would do exactly what this mom is doing…whatever it takes to have this charge paid for by whoever should be responsible.

I work for a medical practice, and am no fan of insurance companies. The bottom line is it was not included in the coverage, so CDPHP should not pay.

I feel it is completely inappropriate for anyone to rely on a hospital or physician’s office for advise on their insurance coverage. There are over 6,000 insurance companies in the country; some offer up to several dozen coverage plans. If you narrow that down to the insurance plans that have a presence in the capital district you would be dealing with approximately 100 insurance companies with possibly 500 – 1,000 possible coverage plans. If you call your own insurance company to inquire if a particular service is covered, they will give you all kinds of disclaimers before giving you a vague response. To expect a health care professional to know what YOUR insurance will cover is just plan ridiculous. If you were in an auto accident would it be reasonable for you to expect the cop to know if your auto insurance will pay to have your car towed from the scene, and pay for a rental car?

I also disagree that this is a “deep, treacherous gap in Child Health Plus”. Most taxpayers are not aware that Medicaid will pay for a patient to take a taxi to physician appointments. I suspect that the burecrats that crafted the Child Health Plus coverage used some good judgment, and wrote the coverage to include the most bang for the available buck.

This article does illustrate an important consideration for whatever national health coverage we eventually end up with. One major problem that I have not seen addressed by any of the phobahs is how much will the individual be responsible for? Will there be any restrictions on what is covered? Will the patient have any out of pocket expense? How do we deal with the 2 pack of cigarettes a day person who claims they are unable to pay a $ 15 physician visit copay?

Air Ambulance is NOT a exclusion of the Child Health Plus contract. It is NOT on the list of exclusions, which leads me to only assume, that when it is not specifically listed as an exclusion, an insurance company can pick and choose what they cover. If they are so adamant about not covering this service, why not put it in the list of exclusions?

THIS was an EMERGENCY situation.

I do not carry the Explanation of Benefits in my purse, just in case, and even if I did, my son was in extreme pain, his blood pressure was spiking, his burns were in an area that could have led to his airway being compromised….I am going to deny him emergency services, when THREE doctors agreed he needed to get to the Westchester Medical Center, ASAP. My son’s burns were severe, and his airway could have been compromised in the 2 1/2 hour drive to Westchester, and he could have died on the road.

I DO NOT live in the “sticks”, as said above AND he was flown from the City of Troy, NOT the site of the accident. I live within close approximation to SEVEN hospitals in the Capital District! SEVEN!! – and not one of them can treat burn victims, with the severity of my son’s burns. Two of the hospitals are within 10 miles of my home….The volunteer companies were on the scene in less then 10 minutes.

Albany Med had a burn unit at one time, but I was told it was not profitable enough to keep it going….Westchester covers all of UPSTATE NY.

My son realizes what he did was irresponsible, but like Sue states above, how many men have done the same thing? This was a learning experience of not only my son, but us as his parents, his siblings, and all the kids at his school.

Someone speeding in a car, and it crashes, should be left to die on the road, because it was “their fault”? Accidents happen all the time. Doctors take an oath to treat all people, with all injuries. Why not the same oath of Health Insurance companies?

I totally agree that the air ambulance companies are charging obscene amounts of money for their services, but who is regulating them?? The State? The Feds?

I am very thankful my son was given the best treatment he could receive. I am very grateful, but to be hit with a $25,000 bill, after I have always had insurance for my family, is unacceptable. This was an EMERGENCY. Time was very important.

For those that think I should have to pay this bill, because it was my son’s fault, and I do not live in a city….Here is a story from a lady who called me to share with me that the same thing happened to her. Her daughter had a rare case of pneumonia. She turned sepsis. All her ograns shut down. She was on life support. The mother was told that her daughter would not make the hour trip to Albany Med (a trauma center), that she would die in the ambulance. AND Albany Med was full and could not accept this dying child. She was flown to a hospital in VT, from Glens Falls. Again, CHPlus – CDPHP, will not pay for this helicopter bill, of $24,800. Now this child did not cause her illness….my question to all of you that disagree that insurance should pay for emergency helicopters…is this ok? Her mom is very grateful that her child lived, and gives credit to the emergency helicopter getting her there as quick as possible, but she, like me had no idea that something that a team of doctors ordered, would not be covered. IT WAS AN EMERGENCY.

A big reason for me to have my story told, is to make parents aware of the fact that the insurance that covers their children, may not cover EVERYTHING in an emergency, and to hopefully nudge some people out there that it is important to cover emergency care, ALL emergency care, as it saves lives, and lessons injuries. I pray that none of you ever find yourselves in one of these situations, and to potentially become financially ruined, even if you have health insurance, and thought you were doing the right thing.

FYI, The New York State Legislature decides what benefits will be covered under Child Health Plus, NOT the big, bad insurance company. My only real point is that perhaps if everyone actually knew what they were paying for when it comes to health insurance, we’d be much better educated BEFORE something awful happens, not after. It’s our responsibility as health care consumers to know what we may be responsible for, just like anything else in life. I can’t tell you the number of times I’ve seen people blow up at the receptionists in their doctors offices when they get a bill for services rendered. Wake up people, it’s not all going to be covered all of the time.

Health insurance has been perverted from it’s original mission – to cover unforseen, catastrophic illnesses, accidents and emergencies.

We now expect all health insurance to cover ANY health related item. That is not what was originally intended and we wonder why premiums are as high as they are. We have collectively caused this problem and only by being willing to accept more personal responsibility and yes, COST, will we ever see our way out of this mess.

I hope that this child will heal well and resume a normal life, I truly do. Also, I am in no way saying that the use of an air ambulance was not warranted in this instance, I believe that his team of medical professionals made the right call based on their established protocols.

It is very sad to see people blaming a child for an “accident”. We all make mistakes and clearly if the policy does not clearly exclude it, then it should be responsible. I know that I have always had health insurance for my family and this state pays plenty for people who don’t work allowing families to be covered from serious hospital stays to diapers! I personally know this family and they have always paid for coverage for their family being self -employed and have always worked to take care of their children. It is not easy acquiring health insurance, loans or anything for that matter when self-employed. We cannot all live in the city and they don’t live in the sticks! When our children are in the hospital we do what the doctors say is needed and think about it later. I have been misinformed by representatives of the insurance companies and have been held responsible for the bill when it was clearly their mistake. These companies continue to get away with this, pay for what is needed!!

I think insurance companies are #$%%. However, it would be impossible to list every single possible exclusion. My policy list what is covered, and has a partial list of the most common things that are excluded.

I am always appauled at how eager people are to rip others apart in the newspaper or on-line. It’s embarassing quite honestly. Have a heart – these are hardworking, law-abiding, tax-paying citizens.

This country is so backwards – I have an idea: Let’s extradite all the illegal aliens that are comitting crimes in our country so that WE don’t have to pay millions of dollars to keep them in our prisons. Then, we could use that money for health care. Or, let’s figure out a different way of dealing with our child molesters and rapists instead of using OUR tax dollars to feed, clothe and educate them.

Having worked for the State of NY, I know first hand that these insurance companies, The State, The Country can manipulate ANYTHING they want. My husband and I pay thousands and thousands of dollars for health insurance. We are never sick, and our two children are never sick. It would almost be better for us to NOT have health insurance and pay out of pocket than to keep giving money to an enless pit. We get ripped off in every way imaginable whether it be at the gas pumps or in the Dr.’s office, and we’re just supposed to say, “oh yeah, sure. I’m glad to pay this enormous bill – I’m happy to pay it as long as my child is being taken care of.” Are you kidding me? I can’t tell you how many times I’ve (and all of you) gone to the Dr.’s office with a problem knowing that they can’t fix the problem that day – yet still, there goes another $50 copay, only to make another apt. another $50 copay – then referred to a specialist – another $50 copay, etc. etc. I need a refill on my allergy Rx – I can’t just get one – I have to make an apt. – oh – there goes another $50.

We have a serious problem on our hands, and your answer is that we should have read our insurance policy to see what is covered and what is not covered? That’s like saying, “here – read this telephone book”. What – you didn’t read the WHOLE telephone book? Shame, shame.

What an expensive mistake this family made by not telling their son “hold on a moment while we get out our insurance policy to see what they can fix on ya babe.”

Expecting this family to pay that ridiculous fee is not o.k. with me, and I’m shocked it’s o.k. with any of you.

Heidi, I am so sorry to hear about what happened to your son, and the insurance hassles you have had to endure. I’m so glad that your son is doing better.

I am disgusted by some of the comments on this blog. What is blaming the victim going to do to help the situation? All that it accomplishes is to make this young man and his family feel worse. Obviously they would go back and change it if they could; of course hindsight is 20/20, but you can’t blame yourself for decisions made in the past. We all make hundreds of decisions every day, big and small. Some turn out to be insignificant while other change our lives, and we can never know which decisions are which. It is part of life.

In addition, the idea that people should have to move closer to an urban area to receive health care is ridiculous. Then we would just have even more overcrowding in our cities and (already crowded) urban health care centers. The right to health care should not be dependent on where you live (or your insurance status, socioeconomic status, etc. but that’s a different debate).

She’s been “a basket case”??!! Gee, what would’ve been her state of mind if her son was permanently and severely disfigured, but the helicopter ride was covered by insurance. I think insurance companies can be slimey, but I personally would be thanking god everyday that my son was alive and well from an incident that could’ve yielded worse results if it wasn’t for quick thinking of everyone involved. To me, my son’s second chance at life would be well worth $25,000; and I would be holding him thankfully everyday instead of complaining about paying for something that saved him from being more disfigured than he could have been.

To start off in the spirit of full disclosure, I have been friends with Heidi for over 25 years. Even if I was not her friend I would have felt compelled to write and defend her.This should never have become a case of defending anyone, it was the insensative blog comments that necissitaed this response.

Heidi is an excellent mother and her children are kind compassionate kids, kids being the operative word here! Accidents happen! You have here a mother who is not taking advantage of the system, is paying a higher monthly premium because she is self employed. So now what some of you are saying is that hard working people should be penalized for being entrepreneurs? If she was a person trying to get out of paying her fair share she would have been on Medicaid and the taxpaying naysayer bloggers would be footing the whole bill! (This is in no way to disparage against people in need that rely on this important program.)

Bamster what is your deal? You are a classic example of what I have always told my children “Think before you Speak.” Really, to say that the fire departments and police departments call the helicopters just to see it, is just plain ludicrous!! How ignorant of you to state that Melrose is in the sticks, Joe was brought to Samaritan Hospital in Troy, it was there that the dedicated staff of professionals deemed it a medical necessity to have Joe airlifted to the Westchester Burn Center. Yes I must admit that in a perfect world (where you must live!) a 15 year old would have not injured himself burning brush. But did you know that this remarkable 15 year old also had the presence of mind to have a working hose nearby in case something got out of control. I do not know of many adults that would think to have done this. Last time I checked accidents happen, that is why they are called accidents! Case Closed!!

Dear Tim, in response to your comment, God forbid something should happen to someone close to you! How much will you be willing to pay if they have an accident? What is your fair share??? Being grateful has nothing to do with this whole mess. By the way Heidi is very grateful to all the men and women who take care of all of us, whether we are injured by our own hand or through the fault of others. She is grateful that her son is healthy and able to resume his normal 15 year old life. However cynical you may be, shouldn’t we all be grateful for that!

Dear Only know what I know, apparently you don’t know that when you are faced with a desperate situation that involves a child or loved one, you don’t stop and say well Gee Whiz how much is this going to cost me? And oh by the way could I have a second opinion while you’re at it! I don’t know about you but that is why I seek out a medical professional, because they have been trained and they do know!!

In conclusion I would like to thank all of you out there that responded with support for Heidi and her family in this trying time, it is greatly appreciated!

Dear hounder, your name says it all! I’m glad you have an extra $25,000.00 lying around, why don’t you share the wealth. You are too ignorant for words. Why don’t you be man or woman enough to write your real name. What makes you even think that she doesn’t hug him every day and is thankful???

IMHO, it is perfectly acceptable and proper to rely on a medical professional to render medical advice. I agree that insurance coverage was , and should be, the furthest thing from the mothers than current concern.
Without coming out and saying in so many words, it seemed to me that the article was trying to say that because the air transport was “a step that doctors deemed necessary for Joe’s emergency care” and that it was recommended by the physicians to use air transport, that the insurance company should pay. I believe one of the major lessons we should take from this story is that so much of our healthcare is controlled and regulated by insurance companies and policy makers in the state and federal legislators.

I continue to disagree with anyone (such as Sue) who believes it is reasonable for a medical professional to know what anyone’s insurance will or will not pay for, and advise the patient.

Let me clarify something to Only know what I know…it was purely a hypothetical statement to emphasize a point….When an emergency presents itself at the hospital, someone immediately asks about the insurance coverage….usually before someone even examines the patient….it seems that someone should be able to take responsibility to help the patient find out what is excluded from his coverage.. someone takes responsibility to find out if the patient HAS coverage..and what it is…and get a copy of the ID card..and someone at the hospital informs the patient that there is a copay with their insurance for the emergency room visit…so why can’t someone find out if something so out of the ordinary as a helicopter is covered…. .Is this feasible??? probably not. Just as it is not feasible that someone scans their insurance policy and the pages of fine print to find out WHAT is excluded in an emergency. If the Insurance company WANTS to be perfectly clear, the exclusions should be in large print in the front of the policy…not on page 32 under some subtitle. I totally agree with Heidi….if it is NOT SPECIFICALLY SPELLED OUT as excluded, then it should be paid. The insurance company can’t suddenly decide to point out something they exclude just because it suits them. I commend Heidi for her willingness to stand up for herself and question this bill.
As to Hounder – from a mom’s standpoint I would be thanking God over and over for my son’s recovery and a “second chance”, however, finding out I owe a 25 thousand dollar bill that would financially devastate my family when I assumed it had been covered, would make me a basket case too. Good Luck Heidi…

I’m not happy to see a person get hurt, but don’t come in here justifying his actions because you have seen grown men at camp grounds using gasoline to start fires. When you saw this happening, did you say something to the “grown men” that their actions were dangerous and that they were setting a bad example for the children that were watching? I doubt it.

If anyone can publish the “protocol” for calling in the helicopter, please do so because I would like to see it. I don’t read about stroke victims, where time is very critical, being flown to Albany Med for treatment. All I ever see is car wreck participants being flown around only to see the next day they are either listed in stable condition or being arraigned at bed side for DWI. At the same time, I don’t know how as a kid in the 70′s (or the genrations before me) ever survived without the M*A*S*H style medi-evac copters just waiting for us to get hurt that we have everywhere today.

In summary, I know you are still bent out of shape so call Obama or Pelosi or Max Baucus and have them add free helicopter transportation to their medical insurance plan so we can speed up the bankrupting of America.

When you put your story out in a public blog, such as The Advocate, you’re inviting all and sundry to opine upon it. If you’re going to get upset about posters who express a different opinion, then perhaps this isn’t the place to “put the word out”.

Barnster – here’s your protocols for this region. Are you really trying to say EMS personnel call a helicopter only when they feel like it? Because if you are, you are seriously ill informed.
Happy Reading!

A different opinion is one thing,, an attack is quite another. How easy it is for everyone to attack this woman and her son. Of course she is happy her son is alive. I do not think she has to be reminded of that. But of course she is upset about a $25,000 bill. I do not think anyone but she is responsible for knowing about what her insurance covers, but who would it have occurred to that the cost is that high? And she did try not to have this helicopter ride. She did the right thing for her son. She was told this was necessary. What were her options? If there is ever a fund to help her pay this bill, I would help.

My heart goes out to Ms. Calhoun and her family. The insurance company should pay the claim. You cannot make the victim the scapegoat. When it is your own child see how you feel about it. Don’t put the cost on the hospital, that has the best interest of the patient at heart, or then administration will mandate that they not use the helicopter service due to budgetary concerns. What are these people in business for (besides the obvious – making money.)Don’t give up the fight.

As for disclosures I am MD. I dont know the specifics of the case but I do know that burns requires highly specialized care, particularly serious ones. It is an unfortunate reality of our society but in order for hospitals to keep units open they have to pay attention to revenews. In other words if AMC kept open the burn unit and then had crushing debt then they would have to close and no-one would receive care.

As for insurance coverages and no coverages its to complex for me. But as far as the doctors acted so what? In their evaluation he needed prompt treatment at a facility that was far away and in order to get there on time he needed an airlift. The fact that insuance did not cover it or that no other options were available its not their fault.

Could this accident have been prevented? I don’t know. But its counterproductive to pounce at the mother. Who is to pay? Well I for one dont really know.

But a larger issue is we need to look at universal coverage. So patietns are covered and hospitals/providers get the money they need to stay in operation.

heidi, you are not at fault,im glad your son was saved as he should be, it is these insurance companies, they pretend they are your best friend until you need them, and then they look for every legal crook n nanny to not pay your bills, but they do not mind taking your money every month..

so much for compassion..you can bet the ones thinking this falls on your shoulders would be singing loudly if it ever happened to them or a loved one.. keep your spirits up and concentrate on your son and his healing, and good luck.

“So, doctors gave the green light for an unusual helicopter transport from Troy to Westchester County.”

Then let the doctors pay for it. If Heidi Calhoun didn’t sign for the financial responsibility for the helicopter, she shouldn’t have to pay for it. Whoever authorized the helicopter is ultimately responsible for the cost. Case closed.

I am torn on this. I am happy that he was taken care of, it was an emergency and decisions had to be made. On hte other hand, I don’t always assume my insurance will cover something. There are numerous times things have been recommended to me that my insurance doesn’t cover. I ususlaly end up taking their advice and paying a higher bill. This bill is obviously more than anything I have enocuntered. However if something isn;t cover, it isn;t covered. To suggest that the doctors should ne responsible is ludicrous, their job is to treat us.

In an emergency situation you are not able to take the time to figure out whether your insurance covers you or not. No one has their full policy memorized. If you were to get in a car accident tomorrow due to another driver’s fault, would you really expect your husband or wife to go to their insurance policy and look up what is or isn’t coverage or would you expect them to race to your side and be very emotional and praying for the best outcome? It’s clear many of you (thank God) have never had to deal with an emergency.

Insurance is there to protect us in cases exactly like this. But in addition, there is no way that a helicopter ride should have cost $24K. Healthcare costs in this country are outrageous.

This is exactly why we need universal coverage. As long as medical necessity is proven, no one should have to worry about bankruptcy because of an emergency.

The State of NY decided they will not pay for helicopter transportation. They did not decide if it was medically necessary or appropriate – just that it would not be paid.

The insurance company is required to follow the rules of New York State. Therefore, they cannot pay for the helicopter ride.

So with all the attention being paid to healthcare reform, let me ask this: Are we willing to let a government entity decide:

1 What is medically necessary

2 What they will pay for (even if it is medically necessary)
Remember, NYS decided it would not pay for this needed helicopter transportation.

Before you answer that, keep in mind that important decisions will be made by politicians and bureaucrats. Rather than voting for what they think is right or wrong, politicians vote for the best deal they can get (either from lobbyists or by trading votes with other legislators who need votes on their pet projects) Burecrats, by their nature, will do anything to prolong and increase their own organization. Have any of you tried to apply for any type of public benefits lately? The income thresholds are one thing. The paperwork requirements are just plain ridiculous!!! And who does all that paperwork benefit – the people who make a career out of pushing paper.

The fee for the helicopter ride does seem very high. It would be interesting to see how much they would be paid if it was covered by insurance. (Some day when we have a lot of time, I’ll provide an inside glimpse at the reality of what healthcare providers charge, and what insurance companies really pay.)

Dave, by your logic, doctors would be responsible for all medical costs, because they are the ones that authorize all medications, procedures, etc. It also makes no sense because it would discourage doctors from performing expensive (but necessary) procedures because they would have to pay for them.

I am in this boat myself, right now. Last Nov, I crashed on my motorcycle trying to avoid debris on the road. I struck a tree with my body at 40+mph when I was ejected from the bike. My carbon fiber helmet was broken, I laid unconscious and I couldn’t breath well when I came to. An oncoming vehicle saw the incident and rushed to my aid. From the time I came to, and I was loaded up and flying away from the incident I was told the entire time from when the call was placed to when I was in the air was less than 25 minutes. The medical staff that assisted me at the scene deemed it medically necessary to get me to Albany Med immediately for fear of head and internal injuries that they cant possibly confirm at the side of the road.

Long story short I spent 2 weeks in the hospital. I can’t even count the number of Ct scans, x-rays and all the things they did for me. I wheel-chaired myself out of the hospital and into my car with 3 broken ribs, punctured spleen and kidney, compound fractured arm, torn ligaments in my leg, and a mild brain swelling from the concussion.

I was sent a bill for $17,000+ for the med-flight. It took 2 calls to my provider to get them their “needed information” to even get the ball rolling to have the helicopter company paid. After hearing many contradicting and meandering statements from the representatives on the phone about how this will be covered it is an extremely uncomfortable process. A big chunk of your pay check goes directly to these “providers”, and in return your supposed to have the peace of mind that unfortunate life threatening circumstances will be taken care of if/when they come up. That is not the case at all.

At this point I received a check from the health care provider, written out to my name, that I am responsible for transferring to the helicopter company, because the headquarters for the company are out of state. This day and age I don’t understand how a billion dollar company cant wire a payment to a company out of state, but whatever at least I have SOME of the payment for the air flight paid for so far.

SOME being the key word; on my statement now I see a $2,000+ charge under the “your responsibility” section. After speaking to my representative, they told me that they won’t cover all the mileage from the flight because there was a closer hospital that could have taken care of my needs! How is this “my responsibility”? Should I have remained conscious and alert enough to kindly tap the pilot on his shoulder and say, “Don’t worry about going all the way to Albany Med to get me the very best life saving care I can get, just dump me off at Amsterdam hospital they will be good enough and my healthcare provider would be happier anyway”? What a joke. It’s the same thing as the family in the article, it wasn’t even the patients decision to pick the place they should receive the care they need, so why are we, the patient’s held responsible? When you get in a cab to go across town, and they driver takes you across the state and back… would you expect to have to pay that fee??? I didn’t think so.

I was told by the company that now I should send the payment they made to me, to the air flight company. In their works “They might agree with receiving some of the payment they asked for, but if they don’t they will bill you again and YOU can forward that back to us and we can take it from there”!!!! You have to be kidding me. I am getting my lawyer!

I’m not going to read all the comments above, but I would inquire about charity care and see if you could get the debt wiped out that way. For the person who mentioned that the hospital should tell her what her insurance covers and what it doesn’t…. It’s beside the point most likely. I don’t know any parent that would say “oh, I can’t afford that… forget it, let my child suffer.” Either way, affordable or not, parents would put their child on that chopper to get them the best care they can. But I agree, $25,000 is enough to break most family budgets I know. Where’s an anonymous check in the mail when you need it! I feel sad that Heidi needs to worry about this bill when she should be spending time with her son!

I find this very interesting. I have CHP for my kids. I am in a very similar situation — middle income, self-employed. Pay for Healthy NY for my husband and I and PAY into CHP as well. It’s not very cheap — it amounts to similar price as private indemnity coverage or approx half of private major medical coverage (HMO).
Since I am in this mid-range area, I’ve been wondering whether I should pay double for the private insurance? Is it really better coverage, or is it basically the same HMO plan?
I wonder if paying full price for an entirely private plan helps — do the doctors really get paid any more or any faster with the private HMO? Would I still suffer the issue of finding the best specialists when needed? Would the helicopter ride really be covered with a private HMO?
I don’t know the full answers to these questions, but I’m starting to believe — no. There really wouldn’t be a difference. I see that the specialists that I wanted to see but didn’t take our Empire CHP HMO, actually didn’t take Empire HMO at all, or most HMOs. I also know people who had private insurance paid for by their employer who found themselves in an emgergency and an ambulance was called for them, and the insurance didn’t cover the ambulance. I’ve actually heard this complaint many times from people. A regular ambulance, not even a helicopter. So, I’m not sure it is the CHP. I actually think it is the insurance policies in general, especially HMOs.
I’m wondering if anyone else knows more about this.
Would the helicopter have been covered with a private HMO?
I’m trying to decide if it’s worth going of the CHP for better coverage, but I think the only way to get better coverage is with a PPO (when you go outside the network, you pay cash and submit the bill for 80% coverage). But I’m not sure even with that kind of plan whether helicopters and ambulances necessarily get covered.

smc – to answer your first question, physicians are paid different rates by different insurance companies for providing the same exact service. While not exact, these numbers are fairly accurate: For 99213 an non-complicated established office visit, Medicare “allows” (more on that later)about $50; NYS employee Empire plan pays $ 47; local 800# elephant # 1 pays $63; local 800# elephant # 2 pays $ 64; Blue Cross pays $56. The Empire Plan and Blue Cross have the most hoops for the MD to jump thru in order to get approval for some testing.

I predict the day will come soon when the USA is like many other countries, in that the best physicians will only take private pay, or maybe the highest paying / less paperwork insurance companies. The MD will spend mote time with you, and the wait will be minimal. Most of us will see the “B” physicians, that have to see twice the number of patients.

My solution: 1) shoot the lawyers (I work in healthcare, and many test are ordered due to CYA) 2) get America healthy 3) realize that everyone has to die sometime, and not insist that everything (as long as someone else is paying for it) be done to keep a 86 year old cancer /diabetic / obese / patient alive (and most likely in misery) for another few days.